Successful NBCA embolization of a T2 aneurysmal bone cyst

Area of Science:

• Interventional Radiology
• Pediatric Orthopedics
• Vascular Surgery

Background:

• Aneurysmal bone cysts (ABC) are benign, expansile bone lesions. Traditional treatment involves surgical curettage, often associated with significant blood loss.
• Selective arterial embolization (SAE) was initially an adjuvant therapy for ABC but is now recognized as a primary treatment modality.

Observation:

• A case study details the SAE technique in a 15-year-old girl with a T2 spinal ABC.
• Digital subtraction angiography guided embolization using N-butyl 2 cyanoacrylate (NBCA).
• Repeat embolization was performed due to persistent pain, leading to symptom resolution and ossification.

Findings:

• SAE demonstrated effectiveness in permanently occluding pathological feeding vessels of the spinal ABC.
• The patient achieved complete symptom resolution and radiographic evidence of lesion ossification at 4-year follow-up.
• The procedure was minimally invasive, safe, and led to long-term positive outcomes.

Implications:

• SAE should be considered a primary treatment option for spinal ABC, particularly in pediatric patients and those with surgically difficult-to-access lesions.
• Meticulous pre-embolization vascular mapping and operator expertise are crucial for successful SAE outcomes.
• NBCA is an effective agent for embolizing ABC feeding vessels, contributing to lesion ossification and patient recovery.